Mental illness in the homeless: How far can society help those in need?

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Imagine living in a world where every decision you make is dictated by society and its members. Imagine being completely reliant on the goodwill of some stranger who decides what is in your best interests, whether you agree or not. Imagine losing all sense of self worth while being subjected to extreme poverty and experiencing anger, depression and pain on a daily basis.

This is what life looks like for the average homeless person. This is the fate that can befall someone who loses everyone he or she has ever loved and cared for. This is what happens when the only possessions an individual has to their name is what they carry with them. This is the result of an unfortunate set of circumstances, whereby someone is left to fend for themselves on the streets, with hope becoming more of an abstract concept as each day passes by

The Facts

The link between mental illness and homelessness is something that has been explored for a long time now – and the results of this research are a damning indictment of society and its failure to tackle the issue. Back in 2015 for instance, not only were depression rates over 10 times higher in the homeless population than people living in society in general, but 40 per cent of those who were surveyed had even attempted suicide at some point during their lives! Just these figures alone begin to paint a very bleak picture of homelessness and how being stuck on the streets with nowhere to go and nobody to turn to is only the beginning of the problem.

‘Hunger, loneliness, physical illness, being beaten up, sometimes raped or set alight are the diet of the homeless

A first-hand account of homelessness recorded in Tamsen Courtenay’s Four Feet Under, a collection of 30 stories  of homeless people in their own words.

The results of recent research carried out by Homeless Link, a national membership charity for organisations working directly with people who become homeless in England, are just as incriminating. According to the people they questioned, 80% of respondents reported some form of mental health issue and 45% said they had been diagnosed with a mental health issue at some point during their lives.

In addition, these matters aren’t helped by common misconceptions that are too often circulated about the homeless. One of the most predominant of these is that they are more interested in taking drugs or other paraphernalia than they are in acquiring basic necessities.

This issue is further complicated by the fact that those who choose to take drugs often have very little choice after they have taken their first hit. It is sadly not uncommon for a homeless person to become  become extremely ill if they suddenly stop taking specific substances: vomiting, diarrhoea and excruciating muscle spasms are just some of what they would endure in the short term. In the long term, there is no guaranteed safe space or form of systematic mental health support to help them recover from their addictions and/or physical dependency on such drugs. This in turn fails to create an incentive for these people to embrace the possibility of changing their ways, and understandably so. Instead, these people are far more likely to be concerned about having enough provisions to see the next sunrise than they will be about receiving adequate mental health support!

Interestingly however, recent figures have estimated that 17.5% of those with mental health issues and 16.7% with alcohol issues would like support but are not receiving it, despite their attempts to reach out for help. This suggests that at least some of these people actually would like to receive support for their mental health issues; they are just more often than not unable to access it.

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There is also the mistaken belief that those who beg on the streets do so because either it is some kind of lifestyle choice or an attempt at making an easy living out of scamming those altruistic enough who stop by to help them. Not only is the prospect of begging for money an abhorrent one to most homeless people, many completely refuse to participate in such an activity at all! Indeed, according to various studies, begging typically emerges in the “middle-late stages” of homelessness once people have already exhausted all other options, and so it would arguably be something that is done as a last resort and not as a quick scheme to make a bit of cash at the expense of one’s own dignity and self-respect.


If there is anything to take away from this information, it is that we must be very cautious about the way in which we discuss those stuck at the lowest tier of society. One only has to read this recent article of an author’s observation of the way in which the homeless are treated in Gloucester to witness the dangers of this thought process. The people who live on the streets in this area are not only ignored but are now at risk of being criminalised thanks to the presence of morally dubious posters like the one above!

‘Now it’s no longer enough to blame them for their plight – we must criminalise them too. Antisocial behaviour orders and a panoply of other bits of nasty legislation all conspire to make homelessness appear villainous and dishonest’

A first-hand account of homelessness recorded in Tamsen Courtenay’s Four Feet Under, a collection of 30 stories of homeless people in their own words.

Overall, what can be deduced from this information is that the suffering and sense of shame bought on by being separated from one’s home and livelihood is only the beginning of a homeless person’s mental health problems. Those unfortunate enough to be stuck in these kinds of situations endure mental health issues beyond the comprehension of the rest of society – and even worse, they are unlikely to be able to access the treatment they need to survive.

With this line of thinking in mind, any organization designed to help the homeless arguably has a moral duty to extend meaningful support to those on every rung of the sociological ladder regardless of who they are or where they come from.


Should we be giving money to the homeless?

There seems to a unanimous agreement that more needs to be done to help the homeless –  a more contentious line of thought seems to be exactly how we should be helping them, and whether it is possible that some forms of aid we could be doing more harm than good in the long term!

It’s almost second nature to give a few spare pennies you have to the homeless person you pass by on a daily basis. Yet there is a deep divide in opinion over whether this social practise is one that should be encouraged. For example, grassroots organisations like Streets Kitchen are in favour of giving money to those far worse of than yourself. Its founder asserts that such an action ‘gives that person the choice’ to do what they please with the cash and believes that those homeless people who do wish to use it to buy drugs are ‘absolutely the minority’. Instead he implores the public to focus on helping to fulfill these peoples minimum needs and requirements, as opposed to morally condemning them for their vices.

‘Whether or not people give money to beggars is a personal decision. Not everyone who begs is homeless and not all homeless people will beg. Nevertheless, people who do beg are often some of the most vulnerable in our society, and many will be struggling with extreme poverty’

Matthew Downie, Head of the National charity Crisis

On the other hand, The Salvation Army – a homeless charity – strongly discourages what it views as a misplaced sense of kindness from those who hand out money to the homeless. Its spokesperson stresses that we must ‘recognise that providing cash can keep people trapped in the endless cycle of homelessness and rough sleeping, particularly for those who are also battling drugs and alcohol issues’ –  a point that is certainly valid and potentially prophetic considering the harm these people can do to themselves in the long run.

Interestingly however, according to Matt Broomfield, a journalist and activist who has taken an interest in the plight of the homeless, giving money as opposed to basic essentials is the right thing to do. This is reflective of his encounters in speaking to those who live on the streets; he states that ‘when I speak to rough sleepers, it is local communities, squatters and grassroots organisations like the London-wide Streets Kitchen which they credit with keeping them alive‘, as opposed to the work of charities, government and other institutions.


Overall, the decision of whether to give out money or essential items such as food or water to the homeless is a complex one. In simple terms, it is an issue that boils down to the idea of how far you believe in and support someone’s freedom of choice to decide their own destiny – whatever the cost. After all, can we really claim to be a truly egalitarian society ( or a society that is as equalitarian in nature as is humanely possible!) by casually dismissing this universal right?

‘If your money funds the final hit, accept that the person would rather be dead. If your act of kindness makes him wake up the next morning and decide to change his life, that’s nice but not your business either

Mark Johnson, founder of User Voice, a charity led and staffed by former homeless addicts

As much as we attempt to better ourselves, it is equally as important to remember that it is not our place to play ‘God’ with peoples lives, regardless of how benevolent we believe our intent to be. On the surface, the idea of ensuring that a homeless person can be afforded with the basic human decency of having something to eat and drink is a morally justifiable one and with good reason. Yet if your motivation behind such an act is to ensure that one that the person in question is unable to attain substances that might do them harm, then is it for you to decide? Or is it for the human being in front of you who has their own motivations, thoughts and feelings?


What can society do?

On a more positive note, efforts have and continue to be made by organisations on behalf of the homeless. For instance, members of Thames Reach can be found on the streets trying to identify, engage with, and support the increasing numbers of rough sleepers who have mental health problems. Furthermore in 2016 a multi-agency task force involving workers from the third sector, the local authority and the NHS identified those homeless people deemed most-at risk due to their complex mental health needs. This resulted in those people finally getting the support they needed as opposed to their health deteriorating rapidly with likely fatal results if they were just left to their own devices.

While all of this is admirable and contributes towards a pragmatic and morally sound outcome for the homeless, let us not forget that more can and should be done. As highlighted already in this article, it is a sad fact that the homeless population currently struggle to access healthcare and tend to be forced to rely on A&E at crisis points. In the words of Rick Henderson, chief executive of Homeless Link, we need more “multi-disciplinary NHS and housing teams who target housing, health and substance misuse issues in unison”.

‘It’s like bailing a leaking boat: As fast as we can get people into housing, we get more people coming in […] We clearly know what to do. We’re just not doing enough of it’

Nan Roman, head of the National Alliance to End Homelessness

Considering how intertwined the issues of mental illness and housing are, it is fair to say that you cannot consider one of these factors without the other if you wish to see positive results. First of all having mental health issues can create the circumstances which can cause a person to become homeless in the first place. At the same time, homelessness itself can also increase the chances of developing a mental health problem. Secondly, without treatment and support, people with mental illness won’t be able to remain in housing once they receive it. Thus without housing, these people face the increased risk of experiencing mental health issues as a result of facing a rough life on the streets. In this way, any attempt to re-home the homeless can be a vicious circle and there is no outcome where either the homeless person or the people attempting to help said person get what they want.

 A Final Word

We may not be able to solve the issue of homelessness with a click of our fingers, but each one of us can take affirmative action in order to play our part. If you believe giving money to be the best solution, then give what you can. Keep in mind that not all homeless people choose to beg because they want to – often they simply need somewhere to stay for the night or really do just want a bottle of water or a sandwich to keep them going.

Alternatively if you believe that it is your moral duty to ensure their basic needs for survival are met, then aside from food and water, consider handing out items such as sleeping bags and painkillers, both of which can help make their lives a little bit easier. In the case of homeless women, greater provision of sanitary products would also be ideal in improving their physical and mental well-being.

To summarise, the more of us who champion the cause of the homeless the more likely they will be afforded with the basic rights, dignity and freedom that they deserve. A more egalitarian outcome is possible, but it will involve the participation of every individual in society to give the poorer among us a more favourable outcome. In light of this article this is especially important in regards to encouraging them to take their physical and mental health issues as seriously as we do our own.

Did you know?

I realise that much of the issues discussed above are likely to provoke a range of opinions from people, and I am very interested in hearing your view on the matter. Does any part of this article resonate with your own beliefs regarding the importance of helping those who often cannot help themselves? Or perhaps you believe an alternative approach would be more beneficial?

Let me know of your thoughts in the comment section below!




Emotional support helplines:

Samaritans :116 123

Rethink Mental Illness advice line 0300 5000 927 (Monday to Friday 09:30-16:00; local rate)

Sane Line:0845 767 8000

Mind also has a useful guide of support and services, which can be found by clicking the link right here

2 thoughts on “Mental illness in the homeless: How far can society help those in need?

  1. If your life was literally a living hell and someone offered you a pill and said “here take this, tonight you won’t be cold, won’t be hungry, scared or ashamed, take this pill and for just a few hours everything will be okay…”

    You would take it! I would take it!

    (Not all) homeless people take drugs? Well duh! What else are you going to do when you’re trapped in a never-ending nightmare with nowhere, no one to turn to?!

    If I was homeless long-term, I would be on anything I could get my hands on just to numb the pain of being alive and I think, many people who look down their noses at these people would be too.

    I have given food and drinks to homeless people, I have also given cigarettes and money and if they buy vodka with that money well that’s their choice, I didn’t give it with conditions attached, I also understand why they would choose vodka over a soggy sandwich which isn’t going to sustain them longer than a few hours anyway.

    psychiatric institutions were (rightfully in most cases) closed down so people could receive care in their own communities but now community care is being cut back on, people with severe mental health issues have no safety net at all. For long-term solutions, that’s where the intervention needs to be.

    I’m going to stop here, sorry for the long comment, I could rant about this for hours.


    1. Hey there. Just to clarify I completely agree with you that if I were homeless I would absolutely do anything I could to numb the pain! It must be a terrible existence to endure!

      Unfortunately it seems like a lot people do have this idea that doing drugs is a terrible thing to do. This is in spite the fact that the majority of these same people are happy to or even feel a need to get tipsy/drunk on a weekly basis on their drug of choice (alcohol). Alas that’s a whole other issue entirely so I won’t go further into this societal hypocrisy for fear of delving into a rant myself!

      Good on you for giving money to the homeless with no conditions attached – honestly I’m a big advocate for the freedom of the individual in general so I naturally lean towards giving money over other stuff myself.

      Good point about the psychiatric institutions too! I hope it didn’t come across as if I were endorsing them (I’ve read around enough to know how bad they were back in the day) – I just found it to be an interesting notion. 🙂

      No need to apologise at all! It’s important to discuss these kind of issues and you made several valid points!


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